Wilderness therapy

Wilderness therapy, as the name suggests, involves outdoor excursions such as camping and backpacking trips that typically last anywhere from several days to several weeks. Nature is utilized as a unique, therapeutic environment for healing, growth, personal discovery, and positive change. Unlike more traditional types of therapy, wilderness therapy isn’t limited to a highly structured, one-hour-per-week therapy session that takes place within the sterile confines of four walls.

In wilderness therapy, the various aspects of surviving safely outdoors are incorporated into the therapeutic approach. For example, learning how to start a fire (in order to cook food and provide warmth) and working together to set up shelter provide excellent opportunities to learn valuable lessons that clients can apply to their day-to-day life. This type of group setting gives participants ample opportunity to develop better interpersonal skills and practice setting appropriate boundaries. Opportunities abound to learn the importance of taking personal responsibility, as the wilderness naturally provides both immediate consequences (e.g. getting rained on at night if a shelter isn’t constructed properly by the group) and rewards (e.g. having a nice fire and cooked food when wood is gathered).

Although therapy clients are removed from their normal surroundings during this time, similar patterns of behavior – whether healthy or maladaptive – inevitably emerge. Clinical staff has the opportunity to observe, support, discuss, and provide feedback to participants on a daily basis. The calming serenity of nature combined with the absence of the myriad distractions and pressures of normal day-to-day life enables therapy clients to reap significant benefits from this intensive type of therapy.

Wilderness therapy is a type of adventure therapy. Many wilderness therapy programs are geared for adolescents who struggle with mental health and/or addiction issues. However, this type of therapy can also be used very effectively for adults, families, and couples struggling with a variety of disorders, life issues, and/or communication and relationship problems. Wilderness therapy programs are often used to help veterans and adults in recovery.

In wilderness therapy, the natural environment is quite unique in that it’s neutral, it can’t be manipulated, and it’s a dramatic change from the clients’ normal life. The setting imitates real life in that clients face challenging situations, pressures, and demands – similar to the ones they experience both at home and in social settings – but without the negative influences that often accompany them.

All of these unique aspects play an important role in the effectiveness of wilderness therapy. Therapists can take advantage of the environment and use various situations (e.g. the frustration of not being able to get a fire started or a conflict with another client) as the focus of discussion in one-on-one and group sessions. Clients gain self-awareness as they examine the issues and problematic behaviors that brought them to therapy in the first place.

Conducting individual sessions in a less formal manner (e.g. while hiking or gathering wood) enhances the rapport between client and therapist. Group sessions give clients an opportunity to talk openly, express feelings, and try out new interpersonal skills in a safe setting. Group sessions give clients the opportunity to learn from each other by listening, sharing, supporting, and giving feedback to each other. The bond that develops with other participants can be particularly beneficial for individuals who have a long history of feeling ostracized or stigmatized by others due to their struggles.

Differentiating Wilderness Therapy from “Boot Camps”

It’s not uncommon to confuse wilderness therapy with outdoor boot camps designed to modify behavior. In fact, some boot camp programs misuse the term “wilderness therapy” in their marketing, even though what they provide isn’t therapy at all. It’s important to understand the differences between the two. For starters, wilderness therapy programs utilize mental health professionals who have at least a master’s degree in psychology, clinical social work, or a related field. Most boot camps, on the other hand, often have no staff members with any type of formal clinical training.

Another significant and important difference between wilderness therapy programs and boot camps is the model on which they’re based. Most boot camps are based on a military model, which often includes the use of punitive measures to shape behavior. Wilderness therapy, on the other hand, is based on the theory and principles of experiential psychology. While both can be beneficial to teens with behavioral problems, wilderness therapy provides a much more in-depth and compassionate approach to bring about desired changes. Rather than simply trying to mold behavior, it addresses the underlying issues that drive it.

Wilderness Therapy versus Wilderness Experience Programs

Many people assume that wilderness therapy is the same thing as wilderness experience programs (often called WEPs for short). Wilderness experience programs, in general, are geared towards personal growth. Outward Bound is probably one of the most well-known and popular WEPs. Although wilderness therapy can be considered a type of WEP – with personal growth as one of the many benefits – there are three primary factors that set it apart from other types of wilderness experience programs. They include the following:

clients are usually chosen based on clinical needs (e.g. an addiction or specific psychiatric disorder) and have individually tailored treatment plans based on those needs

individual and group therapy are key components of the program

each client’s progress is formally evaluated by trained staff

It should be noted that when wilderness therapy is geared towards couples or families, the focus of therapy often isn’t to treat a specific disorder or addiction (although that may be contributing to the problem). Instead, the focus of therapy is often on the relationship dynamics and communication issues occurring between family members or partners.

Contained versus Continuous Flow Wilderness Therapy

Wilderness therapy programs are set up as either “contained” or “continuous flow” programs.

Contained programs include the following elements:

They are time-limited, typically lasting up to 3 weeks

The participants and staff (typically 1 or more licensed therapists, a wilderness guide, and an assistant guide) are together throughout the entire trip

The group is self-sufficient (new supplies aren’t brought in)

Staff is briefed regarding each client’s history and clinical issues (prior to trip)

Individual treatment plans and goals for each client are developed and discussed prior to trip

Continuous flow programs include the following elements:

They are typically much longer than contained programs, and may last as long as 8 weeks

Groups leaders are rotated in and out over the course of the trip

Clients are also coming in (as a new client, in which they meet the group already in progress) and exiting the program (once they graduate) throughout the length of the specific program

Current clients take on the responsibility of helping the new clients as mentors and role models

The therapists meet with the clients weekly (for both individual and group sessions) while wilderness guides stay with the clients day-to-day

History of Wilderness Therapy

Wilderness therapy programs are relatively new, with most dating back only a couple decades. They were strongly influenced by the European Outward Bound program that was first introduced to the U.S. in the 1950s.

Back in the 1970s, however, many programs were questionably run. The so-called treatment providers often lacked proper training, not to mention licensure. Many programs resembled the military-type boot camps described above, utilizing punitive tactics in an attempt to make teens behave properly.

When 16-year-old Aaron Bacon reportedly died from a treatable ulcer during a boot-camp-style wilderness trip in 1994, it caused outrage across the country. According to reports, the young man complained of stomach pain. Instead of getting him to a doctor, the staff accused him of faking his symptoms. They also punished him by taking away his sleeping bag for two weeks and restricting his food.

That tragic incident led to the development of the Outdoor Behavioral Healthcare Research Cooperative. The program, first led by Keith Russell, Ph.D. from Western Washington University, was created to ensure that these programs were researched and evaluated properly. To date, OBHRC has conducted nearly 200 studies. It is currently operating under the direction of University of New Hampshire’s Michael A. Gass, Ph.D.

Another prominent name in the development of wilderness therapy is Madolyn M. Liebing, Ph.D. In 1987, Dr. Liebing helped co-found one of the first therapy programs of this type. She played an instrumental role in integrating therapy into wilderness programs geared towards adolescents.

Currently, there are many wilderness therapy programs available throughout the U.S. Most have programs that focus on very specific populations, such as adolescents who have eating disorders, behavioral problems, or a substance use disorder.

Advantages of Wilderness Therapy

There are many advantages to wilderness therapy, particularly compared to more conventional types of therapy. They include:

Many young adults and their families choose wilderness therapy because they believe it will work better than traditional therapy. Therapy in wilderness is more effective in a shorter period of time than therapy in an office or even in a residential treatment center. There are several factors that make this possible:

The intensive, 24/7 treatment approach can lead to significant progress in a relatively short amount of time

The chances of dropping out of treatment prematurely are greatly reduced

Informal and unorthodox therapy sessions increase rapport between client and therapist. They also help reduce some of the stigma of being in treatment and provide a more relaxed, comfortable atmosphere for the client.

The natural environment provides ample metaphors that clients can apply to their lives in the real world

It removes clients from the distractions and negative influences in their normal lives and gives them the opportunity to work on their issues in a safe and neutral – as well as beautiful – setting

Sharing experiences as a small group out in the wilderness fosters greater group cohesion

Reduced distractions gives clients the opportunity to focus on the issues that led them to therapy

The serenity and beauty of nature facilitates healing

The wilderness can’t be manipulated; consequences of maladaptive behavior or failure to take personal responsibility are natural and often immediate

Wilderness excursions interrupt the client’s normal routine

The environment forces participants to work together and rely on each other, which fosters a sense of community and belonging; it also helps clients develop a greater sense of personal and social responsibility

Any prior sense of entitlement is severely challenged in wilderness therapy

Being in the wilderness without any conveniences and luxuries helps clients recognize how much they take for granted; this gives them a greater appreciate for what they have

The setting provides constant opportunities to learn by experience

Being in nature helps clients develop a greater appreciation for the planet, and increases their sense of responsibility to protect it

Daily opportunities to learn cooperation and the importance of working together with others

Daily opportunities to model healthy behaviors of group leaders in a safe, supportive setting

Benefits of Wilderness Therapy

Wilderness therapy provides a multitude of potential benefits for those who participate in it. They include the following:

Greater self-sufficiency

Improved self-confidence and self-esteem

Emotional healing and healthier emotional expression

Better problem-solving skills

Ability to work as a team towards a mutual goal

Realization that there are natural consequences for one’s actions

Greater recognition of personal weaknesses and strengths

More positive attitude and optimistic outlook

Greater sense of adventure and willingness to venture outside of one’s comfort zone

Increased self-awareness

Better leadership skills

A strong sense of accomplishment

Increased willingness to face one’s fears rather try to avoid or numb them

Greater ability to trust others as well as oneself

Greater sense of personal value and self-worth

Ability to reflect on situations and learn from them

Improved communication and interpersonal skills

Ability to receive, as well as give, helpful feedback

Ability to set healthy and appropriate boundaries

Greater understanding and sense of personal responsibility

Willingness to ask for as well as accept help from others when needed

Ability to respect and appreciate the wants and needs of others

Greater ability to recognize behavior patterns that aren’t healthy

Increase ability to focus and pay attention

Increased ability to recognize unproductive and limiting views and beliefs and change them to ones that are more empowering, healthy, and realistic

Increased self-motivation

More accurate self-assessment of personal limitations and abilities

Ability to adapt more readily to new situations

Disorders, Issues and Conditions that can Benefit from Wilderness Therapy

Wilderness therapy can be a very effective treatment for individuals struggling with various psychiatric disorders, difficult life issues, and other problems, including:

Adolescents and adults recovering from an addiction

Adolescents with behavioral and / or emotional problems / at risk youth

Posttraumatic stress disorder and recovery from trauma

Anxiety disorders

Depression

Bipolar disorder

Low self-esteem

Grief and loss

Autism spectrum disorders

Family conflict

Relationship problems in couples

Veterans struggling to reintegrate into society

The Primary Disadvantage of Wilderness Therapy

Without a doubt, the primary disadvantage of wilderness therapy is the cost. For example, a program in Colorado that typically lasts 8 to 9 weeks has an enrollment fee of just under $3000, and a daily tuition cost of close to $500. That brings the total cost of the program to approximately $30,000 for an 8-week program.

Granted, the length of the program plays a significant role in the total cost. As mentioned earlier, some programs last only 3 weeks, although many last between 30 and 90 days. Daily costs usually run between $200 and $500. A small number of insurance companies may pay for a percentage of the bill, but that still leaves families with a substantial amount coming out of pocket. Currently, however, most insurance companies won’t cover this type of treatment.

The sheer cost of this intensive type of treatment sadly makes it unaffordable for many people who could greatly benefit from it. Many programs do provide options for financing, which can help open doors that would otherwise remain closed. Other types of loans may also be an option to cover the cost. But financing or getting a loan also means incurring a debt that will have to be paid off over time.

In addition to the cost of the therapy program, there are other costs that need to be taken into consideration. One such cost is transportation – not only for the client but also for the family, who may be required to family meetings. For teens with behavioral problems or that are prone to acting out, a “therapeutic transportation service” may be necessary. These services can cost upwards of $2000.

Two other costs that must be considered – and that can add up quickly – include paying for a case manager or educational consultant, as well as placement in a therapeutic boarding school following wilderness therapy. Case manager fees can vary greatly, depending on several different factors. Therapeutic boarding schools often charge anywhere from $100 to $350 per day. For just one week, the boarding school adds another $700 to $2450 to the total bill.

Obviously, most of these additional costs won’t be necessary for couples, families, and most individual adults who choose to participate in a wilderness therapy program.

In the end, the risks versus the benefits must be considered carefully. If you’re considering wilderness therapy for your troubled teen overwhelmed by the daunting cost, you need to remember that not getting your teen the treatment he or she needs could ultimately cost much more. For example, lost time from work, medical expenses if your child attempts suicide or self-mutilates, and legal fees due to many potential scenarios could cost far more in the long run.

Choosing a Program

Choosing the right wilderness therapy program can feel like a daunting task. However, one of the best ways to start (if a therapist or other treatment provider hasn’t already referred you to a specific program) is to do some research and start making some calls. As with any type of treatment, you want to be careful who you choose. Do you due diligence and carefully check out any program you’re considering. Not only will you be paying a lot of money for this type of treatment, you’re also entrusting your loved one’s (or your own) safety and wellbeing to the programs staff leading the trip – and for anywhere from 2 to 12 weeks.

Make sure any program you are considering:

Has a very good reputation and has been providing wilderness therapy for at least a few years (check for any history of complaints, safety concerns, or other negative press)

Is properly insured

Has experienced staff that is properly trained and licensed

Has a solid treatment record

Also, be sure to do your due diligence with regards to therapeutic transportation services, case managers, and aftercare therapeutic boarding schools.

Essentially, be just as thorough checking out a wilderness therapy program as you would a cardiac surgeon who would be performing open heart surgery on a loved one. Several weeks in the wilderness means putting your loved one’s life in the hands of the wilderness therapy staff. It’s not a decision that should be made hastily or lightly.

Wilderness therapy can be a highly effective form of treatment for a variety of issues. It offers several benefits and advantages that you won’t find in other types of therapy, and substantial progress can be made in just a few weeks. For many, it’s a truly life-changing experience.